Provider Demographics
NPI:1316242126
Name:CROSBY STREET INTERNAL MEDICINE, LLC
Entity type:Organization
Organization Name:CROSBY STREET INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-920-9074
Mailing Address - Street 1:594 BROADWAY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3233
Mailing Address - Country:US
Mailing Address - Phone:212-219-8858
Mailing Address - Fax:
Practice Address - Street 1:594 BROADWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3233
Practice Address - Country:US
Practice Address - Phone:718-920-9074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty